28 April 2005Barbara Ehrenreich
Most countries are proud to have a healthcare system. It's an organized way of helping the sick and infirm — a mark of genuine civilization. Not so here, alas, where the health system is rapidly becoming a health hazard. After decades of privatizing, profiteering and insurance company-driven bureaucratization, Florence Nightingale has morphed into Vampira.Healthcare costs are sucking the blood out of the economy, for one thing. Consider poor General Motors, once the nation's flagship corporation and now sinking under the weight of its employee health benefits — which account for $1,500 of the sticker price of each new vehicle. As GM contemplates bankruptcy, other companies thrash around frantically trying to shed their insurance-needy American employees. They downsize and outsource — anything to escape the burden of health costs. The result? Our "jobless recovery": Companies don't want to assume responsibility for their workers' medical bills and — this being the global temple of free enterprise — neither does the government.Then there are the U.S. health system's toxic effects on individuals, and I'm not referring to Vioxx or the approximately 200,000 people who die each year as a result of "medical mistakes," but to its financial effects. Harvard's Elizabeth Warren recently co-wrote a study showing that more than half of all personal bankruptcies are triggered by medical costs, and it's easy enough to see how. If you lose your job — through, say, downsizing or outsourcing — you lose your health insurance, and the uninsured are routinely charged up to three times more than those who have an insurance company to negotiate their hospital bills. As for emergency rooms, which the hardhearted or incurious imagine absorbing all the poor and uninsured — well, the average visit to an ER now costs a little over $1,000, which is a high price to pay for an asthma attack or an infant's fever.Certainly the health system makes plenty of people rich — Big Pharma's overlords, for example, and CEOs like HealthSouth's Richard Scrushy (who received about $267 million in compensation from his company between 1996 and 2002) — but it makes a lot more people poor: indirectly, by inhibiting job growth, and directly, by grinding individuals down to bankruptcy (which, thanks to the new federal bankruptcy law, offers no fresh start to the debt-ridden). Add to this the well-known fact that poverty is a risk factor for dozens of diseases — from asthma to AIDS, from depression to diabetes — and, well, I rest my case.When doctors notice a tissue growing nonstop — as U.S. medical costs are doing — and in the process draining nutrients from the body as a whole, they insist on prompt excision, i.e., cut the thing out before it kills. So too, one might think, economists should be calling for the immediate destruction of the American healthcare system: Stamp it out and drive a stake through its heart. Because Americans will still need healthcare, the solution is obvious: If we can't outsource our illnesses — and there is so far no technology for transferring one's cancer or atrial fibrillation to a starving African or Asian — we can at least outsource our healthcare.It's already happening, in fact, though only in a helter-skelter way.An estimated 2 million Americans cross the borders every year to purchase their prescription meds in Mexico or Canada. U.S. X-rays are increasingly interpreted by radiologists in India.Patients are being globalized too, as hundreds of thousands of them from all parts of the world flock to Manila, Singapore, Bangalore and other centers of low-cost, high-quality care. Some hospitals in India lure the rich with airport-to-hospital bed-car service and post-surgical yoga holidays, and I can foresee cheap, Motel 6-style hospitals springing up in Tijuana for the American working class.All right, it's painful to admit that the nation that produced Osler and Salk, pacemakers and MRIs can't do healthcare anymore. But there are other things we don't do here much anymore, like manufacturing. According to Business Week, companies are increasingly outsourcing their R&D too. In the case of healthcare, it wasn't the science that foiled us (though, with more schools teaching only biblically approved versions of biology, that may soon be a problem too). No, we Americans just couldn't figure out the technology of distributing healthcare to the people who need it. We left the whole business to business — both of the profit-making and private "nonprofit" variety — and business screwed it up.The abolition of the American healthcare system will lead to some difficult readjustments, of course. Our doctors, nurses and technicians, who are among the best-trained in the world, will have to seek work in the emerging Asian centers of medical tourism. As for the estimated 2 million to 3 million insurance company functionaries whose sole business it is to turn down your claims, these folks may be a bit harder to reemploy because they have no counterpart in any civilized, health-providing nation.
Barbara Ehrenreich is the author, most recently, of "Nickel and Dimed: On (Not) Getting By in America" (Owl Books, 2002).
